Healthcare Provider Details

I. General information

NPI: 1376520809
Provider Name (Legal Business Name): GREENWICH PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 STATE ROUTE 29
GREENWICH NY
12834-6109
US

IV. Provider business mailing address

1175 STATE ROUTE 29
GREENWICH NY
12834-6109
US

V. Phone/Fax

Practice location:
  • Phone: 518-692-9634
  • Fax: 518-692-7586
Mailing address:
  • Phone: 518-692-9634
  • Fax: 518-692-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NEIL GEOFFREY TRACHTMAN
Title or Position: OWNER
Credential: MD
Phone: 518-692-9634